| NPI | 1699067819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TN 63931) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 63931) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TN 63931) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105634) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 2833341) | |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2022-03-14 |